United States v. Sandoval-Mendoza ( 2006 )


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  •                Corrected Reprint 1/19/2007
    FOR PUBLICATION
    UNITED STATES COURT OF APPEALS
    FOR THE NINTH CIRCUIT
    UNITED STATES OF AMERICA,                 No. 04-10118
    Plaintiff-Appellee,          D.C. No.
    v.                         CR-01-40201-
    EDUARDO SANDOVAL-MENDOZA,                     SBA-1
    Defendant-Appellant.
         OPINION
    Appeal from the United States District Court
    for the Northern District of California
    Saundra B. Armstrong, District Judge, Presiding
    Argued April 12, 2005
    Submitted August 3, 2005
    San Francisco, California
    Filed December 27, 2006
    Before: Alfred T. Goodwin, Diarmuid F. O’Scannlain, and
    Andrew J. Kleinfeld, Circuit Judges.
    Opinion by Judge Kleinfeld
    19943
    UNITED STATES v. SANDOVAL-MENDOZA             19947
    COUNSEL
    Marc J. Zilversmit, San Francisco, California, for appellant
    Eduardo Sandoval-Mendoza.
    Erika R. Frick, Assistant U.S. Attorney, San Francisco, Cali-
    fornia, for the appellee.
    OPINION
    KLEINFELD, Circuit Judge:
    This drug conspiracy case presents two principal issues.
    The first is whether the district court erred in ordering defense
    counsel not to talk to his client during an overnight recess.
    The second is whether the district court abused its discretion
    in excluding expert testimony about the defendant’s subnor-
    mal intelligence. We reverse.
    FACTS
    Twin brothers, Eduardo and Ricardo Sandoval-Mendoza,
    were convicted of conspiring to sell methamphetamine.
    Eduardo Sandoval-Mendoza sold the drugs. He argues that
    the government entrapped him as a matter of law. He also
    argues that the district court erroneously excluded medical
    evidence of an enormous brain tumor that made him espe-
    19948        UNITED STATES v. SANDOVAL-MENDOZA
    cially vulnerable to entrapment. Ricardo Sandoval-Mendoza
    argues that the government presented insufficient evidence to
    convict him. We treat Ricardo Sandoval-Mendoza’s appeal
    separately in an unpublished disposition.
    A family friend named “Marcos” introduced Eduardo
    Sandoval-Mendoza to “Tony” in February of 2000. Marcos
    and Tony were government informants. Sandoval-Mendoza
    sold them about 12 pounds of methamphetamine in three sep-
    arate deals.
    Sandoval-Mendoza testified. He admitted selling the drugs,
    but claimed the government entrapped him. He claimed the
    government informants knew a large brain tumor rendered
    him especially susceptible to suggestion and preyed upon his
    weakness. The tumor was diagnosed in 1992, eight years
    before the methamphetamine sales. At first, Sandoval-
    Mendoza took medication to shrink the tumor, but quit
    because of the side effects. He resumed only when his doctor
    told him the tumor would kill him without the medicine.
    Sandoval-Mendoza was depressed. He was worried about
    dying and about providing for his wife and five children. And
    he was worried about the impotence his tumor caused. He
    talked about his problems with Marcos, his sister’s boyfriend.
    Sandoval Mendoza testified that Marcos told him he made
    $5,000 to $10,000 a week selling drugs. Marcos and Tony
    suggested that Sandoval-Mendoza sell drugs to make some
    money to support his family after he died.
    Sandoval-Mendoza testified that he refused to sell drugs for
    several months, lacking both the experience and the inclina-
    tion. But eventually he caved in, making three sales to Marcos
    and Tony. He testified that he sold them drugs only because
    they used his depression and fear to persuade him, and that he
    never sold drugs to anyone else.
    Sandoval-Mendoza’s account is not entirely credible. On
    wiretap recordings he sounds suspiciously like an experienced
    UNITED STATES v. SANDOVAL-MENDOZA            19949
    drug dealer, not a neophyte. He testified that a relative, a fugi-
    tive drug dealer in Mexico, told him what to say and how to
    portray himself. This relative also connected him with suppli-
    ers in Los Angeles.
    Neither of the government informants took the stand to
    contradict Sandoval-Mendoza’s entrapment defense or offer
    an alternative explanation. Tapes of their conversations with
    Sandoval-Mendoza came into evidence, but the government
    did not put them on the stand. And the informants had an
    incentive to entrap Sandoval-Mendoza. The government paid
    them money for their assistance as well as offering benefits in
    their own criminal cases.
    To bolster his entrapment defense, Sandoval-Mendoza
    sought to introduce expert testimony explaining that his large
    brain tumor damaged his intelligence, memory, and judgment,
    making him especially susceptible to suggestion. Sandoval-
    Mendoza’s lawyer’s theme for the jury was “thou shalt not
    put a stumbling block before the blind.”1 His defense theory
    was that the government improperly induced a sick and sug-
    gestible man to sell drugs.
    The district court admitted some evidence in support of
    Sandoval-Mendoza’s defense, permitting his sister and ex-
    wife to testify that his tumor made him forgetful. But it
    excluded all the defense expert testimony. The defense had a
    neuropsychologist and a neurologist ready to testify that the
    brain tumor did indeed impair Eduardo’s intellect and judg-
    ment. After an in camera Daubert2 hearing, the district court
    excluded the expert testimony, partly because it did not dem-
    onstrate the tumor caused suggestibility and partly because it
    would be long and confusing. Sandoval-Mendoza argues that
    this error requires reversal.
    1
    Leviticus 19:14.
    2
    See Daubert v. Merrell Dow Pharm., Inc., 
    509 U.S. 579
    , 592-95
    (1993).
    19950           UNITED STATES v. SANDOVAL-MENDOZA
    The government cross examined Sandoval-Mendoza over
    the course of two days, spanning a morning recess, a lunch
    recess, an overnight recess, and another recess on the second
    day. The district court ordered Sandoval-Mendoza and his
    lawyer not to communicate with each other during the
    recesses regarding Sandoval-Mendoza’s testimony, including
    the overnight recess. The district court allowed communica-
    tion on other matters,“just not concerning his testimony.”
    Once cross examination was over, the prohibition was lifted.
    Sandoval-Mendoza was convicted and sentenced to 235
    months. He appeals, claiming entrapment as a matter of law,
    error in excluding his expert witnesses’ testimony, error in
    limiting his consultation with counsel, and error on other
    grounds.
    ANALYSIS
    I.       Entrapment.
    The jury instruction required the government to prove
    beyond a reasonable doubt that Sandoval-Mendoza was not
    entrapped. The jury decided that Sandoval-Mendoza was not
    entrapped. But Sandoval-Mendoza argues that he was entrap-
    ped as a matter of law. We review de novo.3 We “will not dis-
    turb the jury’s finding unless, viewing the evidence in the
    government’s favor, no reasonable jury could have concluded
    that the government disproved the elements of the entrapment
    defense.”4
    [1] Entrapment has two elements: “government inducement
    of the crime and the absence of predisposition on the part of
    3
    United States v. Si, 
    343 F.3d 1116
    , 1125 (9th Cir. 2003) (citation omit-
    ted).
    4
    United States v. Mendoza-Prado, 
    314 F.3d 1099
    , 1102 (9th Cir. 2002)
    (citation omitted).
    UNITED STATES v. SANDOVAL-MENDOZA                   19951
    the defendant.”5 Inducement is “any government conduct cre-
    ating a substantial risk that an otherwise law-abiding citizen
    would commit an offense.”6 We assume Sandoval-Mendoza
    proved inducement because the government did not dispute
    that its informants proposed the drug sales.
    [2] Even so, Sandoval-Mendoza does not establish absence
    of predisposition as a matter of law. “Where the Government
    has induced an individual to break the law and the defense of
    entrapment is at issue, as it was in this case, the prosecution
    must prove beyond reasonable doubt that the defendant was
    disposed to commit the criminal act prior to first being
    approached by Government agents.”7 The government pres-
    ented evidence Sandoval-Mendoza was predisposed to sell
    drugs, including wiretap recordings of him talking as though
    he were an experienced drug dealer. Offering to buy drugs
    from a drug dealer is not entrapment, even if the government
    “sets the dealer up” by providing an informant pretending to
    be a customer, because the dealer is already predisposed to sell.8
    In order to prove he was entrapped as a matter of law,
    Sandoval-Mendoza must “point to undisputed evidence mak-
    ing it patently clear that an otherwise innocent person was
    induced to commit the illegal act by trickery, persuasion, or
    fraud of a government agent.”9 He argues that his testimony
    that he resisted the pressure to sell drugs to the government
    informants and never sold drugs to anyone else was undis-
    5
    United States v. Skarie, 
    971 F.2d 317
    , 320 (9th Cir. 1992).
    6
    United States v. Poehlman, 
    217 F.3d 692
    , 698 (9th Cir. 2000) (citation
    omitted).
    7
    Jacobson v. United States, 
    503 U.S. 540
    , 548-549 (1992) (citation
    omitted).
    8
    United States v. Poehlman, 
    217 F.3d 692
    , 701 (9th Cir. 2000) (“Where
    government agents merely make themselves available to participate in a
    criminal transaction, such as standing ready to buy or sell illegal drugs,
    they do not induce commission of the crime.”).
    9
    United States v. Mendoza-Prado, 
    314 F.3d 1099
    , 1102 (9th Cir. 2002).
    19952            UNITED STATES v. SANDOVAL-MENDOZA
    puted because he testified and the informants did not. But the
    jury did not have to believe Sandoval-Mendoza. Uncontra-
    dicted testimony is not necessarily undisputed evidence.10
    Jurors may reject uncontradicted testimony when cross exam-
    ination, other evidence, or their own common sense and ordi-
    nary experience convince them the testimony is probably
    false. “Even perfectly plausible allegations can be disbelieved
    if they occur during the course of a generally implausible
    account.”11 The wiretap recordings in which Sandoval-
    Mendoza pretended to be or really was an experienced drug
    dealer belie his testimony. The jury could have believed
    Sandoval-Mendoza’s drug dealer relative coached him and he
    was just pretending. But it didn’t have to.
    [3] The jury could have found that Sandoval-Mendoza was
    entrapped. But its conclusion to the contrary was supported by
    enough evidence to meet the Jackson12 standard. This is not
    a case like Jacobson,13 where the government failed to present
    any evidence of predisposition at all. Entrapment was prop-
    erly left to the jury.
    10
    Wilbur-Ellis Co. v. The M/V Captayannis “S”, 
    451 F.2d 973
    , 974 (9th
    Cir. 1971) (per curiam) (holding “the court is not bound to accept uncon-
    troverted testimony at face value if it is improbable, unreasonable or other-
    wise questionable.”) (citing Quock Ting v. United States, 
    140 U.S. 417
    ,
    420-21 (1891)).
    11
    Grotemeyer v. Hickman, 
    393 F.3d 871
    , 879 (9th Cir. 2004) (“When
    a witness’s account is as unlikely as the events portrayed in a Marc Cha-
    gall painting, the jury is entitled to reject the testimony in its entirety, dis-
    believing both the reasonable and the unreasonable aspects.”).
    12
    Jackson v. Virginia, 
    443 U.S. 307
    , 319 (1979) (holding “the relevant
    question is whether, after viewing the evidence in the light most favorable
    to the prosecution, any rational trier of fact could have found the essential
    elements of the crime beyond a reasonable doubt.”) (emphasis in original)
    (citation omitted).
    13
    Jacobson v. United States, 
    503 U.S. 540
    (1992).
    UNITED STATES v. SANDOVAL-MENDOZA                   19953
    II.    The order limiting attorney-client discussion.
    Sandoval-Mendoza testified over the course of three days.
    The government’s cross examination spanned a morning
    recess, a lunch recess, an overnight recess, and another morn-
    ing recess the following day. The district court instructed
    Sandoval-Mendoza and his lawyer not to discuss his testi-
    mony during any of the recesses, but permitted them to dis-
    cuss anything else. Sandoval-Mendoza’s lawyer objected and
    was overruled. When the cross examination ended, the district
    court permitted Sandoval-Mendoza and his lawyer to discuss
    his testimony before redirect.
    Sandoval-Mendoza argues that the district court’s order
    prohibiting him from discussing his testimony with his lawyer
    during the recesses amounted to a structural error under
    Geders v. United States14 and Perry v. Leeke.15 Perry and
    Geders reach opposite conclusions based on different facts. In
    Geders, the trial court prohibited all communication between
    the defendant and his lawyer during an overnight recess
    between direct and cross examination. The Supreme Court
    held that this prohibition required reversal because it deprived
    the defendant of his Sixth Amendment right to counsel.16 In
    Perry, the trial court prohibited all communication between
    the defendant and his lawyer during a fifteen minute recess
    between direct and cross examination. The Supreme Court
    held that this prohibition did not violate the Sixth Amendment.17
    Perry distinguished Geders, on the ground that “the normal
    consultation between attorney and client that occurs during an
    overnight recess would encompass matters that go beyond the
    content of the defendant’s own testimony — matters that the
    14
    Geders v. United States, 
    425 U.S. 80
    (1976).
    15
    Perry v. Leeke, 
    488 U.S. 272
    (1989). See also United States v. Santos,
    
    201 F.3d 953
    (7th Cir. 2000); Mudd v. United States, 
    798 F.2d 1509
    (D.C.
    Cir. 1986).
    16
    Geders v. United States, 
    425 U.S. 80
    , 91-92 (1976).
    17
    Perry v. Leeke, 
    488 U.S. 272
    (1989).
    19954          UNITED STATES v. SANDOVAL-MENDOZA
    defendant does have a constitutional right to discuss with his
    lawyer, such as the availability of other witnesses, trial tactics,
    or even the possibility of negotiating a plea bargain.”18
    The facts of this case fall in the middle. The district court
    instructed Sandoval-Mendoza’s lawyer, “You can communi-
    cate. Just not concerning cross, his testimony, now that he’s
    on cross-examination, unless that’s concluded. That doesn’t
    mean you can’t talk with your client at all, just not concerning
    his testimony.” On the one hand, the district court prohibited
    communication between Sandoval-Mendoza and his lawyer
    during an overnight recess, suggesting Geders controls. On
    the other hand, the district court only prohibited Sandoval-
    Mendoza and his lawyer from discussing his testimony, rather
    than anything at all, suggesting Perry controls.
    The core issue is whether prohibiting a defendant and his
    lawyer from discussing his testimony during an overnight
    recess violates the Sixth Amendment. Two other circuits have
    addressed this question. In Mudd v. United States, the District
    of Columbia Circuit held a similar prohibition unconstitu-
    tional under Geders.19 And in United States v. Santos, the
    Seventh Circuit held a similar prohibition unconstitutional
    under Perry.20
    This is a difficult question. Cross examination best exposes
    the truth when a witness must answer questions unaided.
    Coaching may vitiate its value. But it is hard to see how a
    defendant and his lawyer can communicate without implicit
    coaching. The Seventh Circuit suggests that “the judge may
    instruct the lawyer not to coach his client” but may not pro-
    hibit discussion of the client’s testimony.21 But that is not a
    workable rule, because coaching is implicit in any discussion
    18
    Perry v. Leeke, 
    488 U.S. 272
    , 284 (1989).
    19
    Mudd v. United States, 
    798 F.2d 1509
    (D.C. Cir. 1986).
    20
    United States v. Santos, 
    201 F.3d 953
    (7th Cir. 2000).
    21
    United States v. Santos, 
    201 F.3d 953
    , 965 (7th Cir. 2000).
    UNITED STATES v. SANDOVAL-MENDOZA                     19955
    of a defendant’s testimony, even if the defendant’s lawyer
    tries his best to avoid coaching.22
    [4] We conclude that any overnight ban on communication
    falls on the Geders side of the line and violates the Sixth
    Amendment. That seems the fairer reading of Perry, which
    only permitted prohibitions on communication between a
    defendant and his lawyer during a “brief recess.”23 Perry rec-
    ognized a defendant has a “constitutional right” to discuss
    matters other than his own testimony with his lawyer, “such
    as the availability of other witnesses, trial tactics, or even the
    possibility of negotiating a plea bargain,” during an overnight
    recess.24 And it conceded that “such discussions will inevita-
    bly include some consideration of defendant’s ongoing testimo-
    ny.”25 Indeed, it is hard to see how a defendant’s lawyer could
    ask him for the name of a witness who could corroborate his
    testimony or advise him to change his plea after disastrous
    testimony, subjects Perry expressly says a defendant has a
    right to discuss with his lawyer during an overnight recess,
    without discussing the testimony itself.
    [5] Thus, we conclude that trial courts may prohibit all
    communication between a defendant and his lawyer during a
    brief recess before or during cross-examination, but may not
    restrict communications during an overnight recess.26 This
    22
    As has been recognized for millennia, even neutral judges find it hard
    to avoid teaching a witness what would be useful to him, when judges
    question the witness. “Be thorough in the interrogation of witnesses, and
    be careful in thy words, lest from them they learn to utter falsehood.”
    Aboth 1:9 (J. Israelstam trans.), in 4 The Babylonian Talmud 7 (I. Epstein
    ed. 1935).
    23
    Perry v. Leeke, 
    488 U.S. 272
    , 283-84 (1989).
    24
    Perry v. Leeke, 
    488 U.S. 272
    , 284 (1989).
    25
    Perry v. Leeke, 
    488 U.S. 272
    , 284 (1989).
    26
    “We merely hold that the Federal Constitution does not compel every
    trial judge to allow the defendant to consult with his lawyer while his testi-
    mony is in progress if the judge decides that there is a good reason to
    interrupt the trial for a few minutes.” Perry v. Leeke, 
    488 U.S. 272
    , 284-
    285 (1989).
    19956          UNITED STATES v. SANDOVAL-MENDOZA
    simple rule is consistent with the reasoning of Geders and
    Perry. And it has several other advantages. First, it is easy to
    understand and apply. Second, it dispenses with pretense.
    Jurors can believe that a defendant did not communicate with
    his lawyer during a bathroom break. But only a lawyer more
    wedded to words than common sense can believe that a defen-
    dant communicated with his lawyer during an overnight
    recess without at least implicitly discussing his testimony.
    Third, as Geders explains, prosecutors and judges can
    address the coaching problem without prohibiting communi-
    cation during an overnight recess. The trial court may “exer-
    cise reasonable control” over the order and timing of direct
    and cross examination in order to “make the interrogation and
    presentation effective for the ascertainment of the truth.”27 For
    instance, it “may direct that the examination of the witness
    continue without interruption until completed” or “arrange the
    sequence of testimony so that direct- and cross-examination
    of a witness will be completed without interruption.”28 If a
    defense lawyer strings out direct examination until the usual
    time for the evening recess, the court can delay the recess and
    give the prosecutor a few minutes to get in some cross exami-
    nation.
    Thus, we conclude that the district court erred in prohibit-
    ing Sandoval-Mendoza and his lawyer from discussing his
    testimony during an overnight recess. But does the error
    require reversal? While Geders implies it does,29 Geders, a
    1976 decision, preceded many recent Supreme Court deci-
    sions requiring prejudice as well as constitutional error for rever-
    sal.30 Still, under the recent Supreme Court decision in United
    States v. Gonzales-Lopez,31 if an error is structural, prejudice
    27
    Fed. R. Evid. 611(a).
    28
    Geders v. United States, 
    425 U.S. 80
    , 90 (1976).
    29
    Geders v. United States, 
    425 U.S. 80
    , 91 (1976).
    30
    E.g. Neder v. United States, 
    527 U.S. 1
    , 8 (1999).
    31
    United States v. Gonzales-Lopez, 548 U.S. ___ (2006).
    UNITED STATES v. SANDOVAL-MENDOZA              19957
    is irrelevant. We need not decide whether or not an overnight
    prohibition of communications regarding the defendant’s tes-
    timony is structural error, because another error, described
    below, independently requires reversal.
    III.   The Excluded Expert Witness Testimony.
    “We review the district court’s decision to exclude expert
    witness testimony for abuse of discretion.”32
    Sandoval-Mendoza wanted to present expert testimony
    concerning his mental condition and susceptibility to sugges-
    tion. He offered two expert witnesses: Dr. Michael Shore, a
    neuropsychologist, and Dr. J. Richard Mendius, a neurologist.
    The prosecutors also proposed expert witnesses: Dr. Ronald
    H. Roberts, a neuropsychologist, and Dr. Richard Cuneo, a
    neurologist. The district court held a Daubert33 hearing on
    whether any of these expert witnesses would be permitted to
    testify.
    Defense witness Michael Shore, Ph.D., is a psychologist
    with extensive clinical and teaching experience in neuropsy-
    chology, focusing on the rehabilitation of patients suffering
    from brain damage caused by strokes, tumors, and other
    causes. He testified that Sandoval-Mendoza suffered from an
    unusually large pituitary tumor measuring 2 x 2 x 3 centime-
    ters, about the size of an apricot, when diagnosed. The tumor
    compressed Sandoval-Mendoza’s frontal lobe, temporal lobe,
    and thalamus, probably causing damage. Medication eventu-
    ally shrank Sandoval-Mendoza’s tumor to some degree, but
    could not reverse any brain damage.
    The relationship between brain damage and cognitive
    impairment is well-documented. Tumors like Sandoval-
    32
    United States v. Bahena-Cardenas, 
    411 F.3d 1067
    , 1078 (9th Cir.
    2005) (citation omitted).
    33
    Daubert v. Merrell Dow Pharm., 
    509 U.S. 579
    (1993).
    19958        UNITED STATES v. SANDOVAL-MENDOZA
    Mendoza’s may affect mental condition in two ways. First,
    damage to the pituitary gland may affect thyroid production,
    causing mood disorders, including depression. Second, direct
    damage to the frontal lobe, temporal lobe, and thalamus may
    affect memory, decision-making, judgment, mental flexibility,
    and overall intellectual capacity. In particular, damage to the
    frontal lobe often affects concentration, focus, learning, mem-
    ory, decision-making, reasoning, judgment, and problem-
    solving, according to Dr. Shore.
    A battery of routine and widely-accepted tests showed
    Eduardo suffered from brain damage affecting his cognitive
    condition. Although an performance IQ test showed border-
    line mental retardation and a mental age of eleven, Dr. Shore
    concluded Sandoval-Mendoza’s school and work history were
    not consistent with retardation, and attributed the test results
    to his tumor. A classic nineteenth-century study showed fron-
    tal lobe damage causes a person to have “the passions of a
    man but the mind of a child,” increasing suggestibility. In
    Sandoval-Mendoza’s case, the brain damage apparently
    affected the “passions of a man” as well, because the tumor
    made him impotent.
    Defense witness Dr. J. Richard Mendius, M.D., is a board-
    certified neurologist with additional expertise in clinical
    neurophysiology. He testified that a magnetic resonance
    imaging test showed Sandoval-Mendoza suffers from an
    unusually large pituitary tumor. When the tumor shrank after
    treatment, the frontal lobe herniated into the empty space. The
    tumor also caused atrophy of the inside of the left temporal
    lobe and penetrated a bone separating the pituitary gland from
    the brain stem. Brain damage of this kind tends to affect judg-
    ment, memory, and emotions connected to memory. A perfor-
    mance IQ test suggested a very low level of intellectual
    function. Both Shore and Mendius testified that they knew of
    no studies specifically linking brain damage of this kind with
    susceptibility to inducement to commit crimes. But they noted
    that it commonly causes disinhibition.
    UNITED STATES v. SANDOVAL-MENDOZA             19959
    Prosecution witness Ronald H. Roberts, Ph.D., is a neurop-
    sychologist who mainly testifies as an expert witness. Roberts
    agreed Sandoval-Mendoza suffered from an unusually large
    tumor. However, he believed Sandoval-Mendoza was deliber-
    ately underperforming on memory texts. He also believed the
    tumor did not significantly affect Sandoval-Mendoza’s perfor-
    mance IQ test result. Though he did not contradict the deter-
    minations from the MRI films that Sandoval-Mendoza had an
    extremely large tumor, he gave the opinion that on the mem-
    ory tests, Sandoval-Mendoza was faking a worse memory
    than he really had.
    Prosecution witness Dr. Richard Cuneo, M.D., is a neurolo-
    gist. Cuneo agreed Sandoval-Mendoza suffered from an
    unusually large pituitary tumor near areas of the brain control-
    ling behavior and cognition. But medical understanding of
    behavior and cognition is preliminary and inconclusive. Dr.
    Cuneo thought the studies presented were inadequate to show
    that Sandoval-Mendoza’s tumor and brain damage affected
    his behavior and cognition because the studies were retrospec-
    tive and involve small samples. A patient of Dr. Cuneo’s had
    a similar tumor that neither caused brain damage nor affected
    behavior and cognition. Sandoval-Mendoza’s magnetic reso-
    nance imaging test did not show any brain damage, in Dr.
    Cuneo’s opinion. While some brain tumors may cause disin-
    hibition or greater susceptibility to influence, pituitary tumors
    do not, unless they are even larger than Sandoval-Mendoza’s.
    Dr. Cuneo conceded that Sandoval-Mendoza’s performance
    IQ test was borderline “retarded” and mentally retarded peo-
    ple are “known to be susceptible to the influence of others.”
    After the Daubert hearing, the district court excluded the
    expert testimony as “not relevant to the entrapment defense”
    because it “does not tend to show either inducement or a lack
    of predisposition attributable to the tumor.” The court based
    its ruling on the expert testimony’s “lack of scientific validi-
    ty” and “absence of ability to make a causal connection”
    between the tumor and inducement or predisposition. Alterna-
    19960           UNITED STATES v. SANDOVAL-MENDOZA
    tively, it concluded that the “probative value” of the expert
    testimony was “outweighed by the dangers of confusing the
    issues, misleading the jury, and creating undue delay,” and
    “would be extremely confusing to both the court and the jury”
    especially “given the fact that the defense witnesses will then
    be rebutted by government witnesses.”
    As a consequence, only Sandoval-Mendoza himself, his ex-
    wife, and his sister could testify that his brain tumor made
    him forgetful and suggestible. The defense had another wit-
    ness prepared to testify that Sandoval-Mendoza once drank
    his own urine sample, having forgotten what it was, but the
    witness disappeared after the prosecutor advised her that as an
    illegal alien she could be putting herself at risk of deportation.
    But jurors might well disregard the lay evidence that came in
    as biased and lacking scientific foundation, since they were
    deprived of medical evidence.
    Although the abuse of discretion standard of review is lib-
    eral, the district court’s decision to exclude the expert testi-
    mony creates a “definite and firm conviction that the district
    court committed a clear error of judgment.”34 Daubert makes
    the district court a gatekeeper, not a fact finder. When credi-
    ble, qualified experts disagree, a criminal defendant is entitled
    to have the jury, not the judge, decide whether the govern-
    ment has proved its case.35
    [6] Federal Rule of Evidence 702 governs the admission of
    expert opinion testimony.36 Under Daubert37 and Kumho Tire,38
    34
    Clausen v. M/V New Carissa, 
    339 F.3d 1049
    , 1055 (9th Cir. 2003).
    35
    Dorn v. Burlington N. Santa Fe R.R. Co., 
    397 F.3d 1183
    , 1196 (9th
    Cir. 2005).
    36
    “If scientific, technical, or other specialized knowledge will assist the
    trier of fact to understand the evidence or to determine a fact in issue, a
    witness qualified as an expert by knowledge, skill, experience, training, or
    education, may testify thereto in the form of an opinion or otherwise.”
    Fed. R. Evid. 702.
    37
    Daubert v. Merrell Dow Pharms, 
    509 U.S. 579
    (1993).
    38
    Kumho Tire Co. v. Carmichael, 
    526 U.S. 137
    (1999).
    UNITED STATES v. SANDOVAL-MENDOZA                    19961
    only relevant and reliable expert opinion testimony is admissi-
    ble. Expert opinion testimony is relevant if the knowledge
    underlying it has a “valid . . . connection to the pertinent inqui-
    ry.”39 And it is reliable if the knowledge underlying it “has a
    reliable basis in the knowledge and experience of [the rele-
    vant] discipline.”40
    [7] Trial courts must exercise reasonable discretion in eval-
    uating and in determining how to evaluate the relevance and
    reliability of expert opinion testimony.41 Daubert and Kumho
    Tire suggest factors trial courts may consider when evaluating
    the relevance and reliability of expert opinion testimony. For
    example, in evaluating the reliability of scientific expert opin-
    ion testimony, trial courts may consider: “(1) whether the sci-
    entific theory or technique can be (and has been) tested, (2)
    whether the theory or technique has been subjected to peer
    review and publication, (3) whether there is a known or
    potential error rate, and (4) whether the theory or technique
    is generally accepted in the relevant scientific community.”42
    Of course, “there are many different kinds of experts, and
    many different kinds of expertise,” so these factors “may or
    may not be pertinent in assessing reliability, depending on the
    nature of the issue, the expert’s particular expertise, and the
    subject of his testimony.”43
    39
    Kumho Tire Co. v. Carmichael, 
    526 U.S. 137
    , 149 (1999) (quoting
    Daubert v. Merrell Dow Pharms, 
    509 U.S. 579
    , 592 (1993)).
    40
    Kumho Tire Co. v. Carmichael, 
    526 U.S. 137
    , 149 (1999) (quoting
    Daubert v. Merrell Dow Pharms, 
    509 U.S. 579
    , 592 (1993)).
    41
    Kumho Tire Co. v. Carmichael, 
    526 U.S. 137
    , 152 (1999); Mukhtar
    v. Cal. State Univ., 
    299 F.3d 1053
    , 1064 (9th Cir. 2002) (“A trial court not
    only has broad latitude in determining whether an expert’s testimony is
    reliable, but also in deciding how to determine the testimony’s reliabili-
    ty.”) (citation omitted).
    42
    Mukhtar v. Cal. State Univ., 
    299 F.3d 1053
    , 1064 (9th Cir. 2002)
    (summarizing Daubert v. Merrell Dow Pharms., 
    509 U.S. 579
    , 592-94
    (1993)).
    43
    Kumho Tire Co. v. Carmichael, 
    526 U.S. 137
    , 150 (1999).
    19962           UNITED STATES v. SANDOVAL-MENDOZA
    [8] When evaluating specialized or technical expert opinion
    testimony, “the relevant reliability concerns may focus upon
    personal knowledge or experience.”44 Because medical expert
    opinion testimony “is based on specialized as distinguished
    from scientific knowledge, the Daubert factors are not
    intended to be exhaustive or unduly restrictive.”45 Under our
    decision in Sullivan v. United States Dep’t of the Navy, the
    district court “applied an inappropriately rigid Daubert stan-
    dard to medical expert testimony” by not accepting what “a
    good [physician] would in determining what is reliable
    knowledge in the [medical] profession.”46 A trial court should
    admit medical expert testimony if physicians would accept it
    as useful and reliable. Utility to the jury of medical expert tes-
    timony should be determined by what physicians would
    accept as useful.
    [9] The district court concluded that the proposed medical
    expert opinion testimony was unreliable because it did not
    conclusively prove Sandoval-Mendoza’s brain tumor caused
    susceptibility to inducement or a lack of predisposition. But
    medical knowledge is often uncertain. The human body is
    complex, etiology is often uncertain, and ethical concerns
    often prevent double-blind studies calculated to establish sta-
    tistical proof. This does not preclude the introduction of medi-
    cal expert opinion testimony when medical knowledge
    “permits the assertion of a reasonable opinion.”47
    [10] Predisposition or its absence is the focus of an entrap-
    ment defense.48 Therefore, medical expert opinion testimony
    showing that a medical condition renders a person unusually
    44
    Kumho Tire Co. v. Carmichael, 
    526 U.S. 137
    , 150 (1999).
    45
    Sullivan v. U.S. Dep’t of the Navy, 
    365 F.3d 827
    , 834 (9th Cir. 2004).
    46
    Sullivan v. U.S. Dep’t of the Navy, 
    365 F.3d 827
    , 833-34 (9th Cir.
    2004).
    47
    United States v. Finley, 
    301 F.3d 1000
    , 1007 (9th Cir. 2002) (citation
    omitted).
    48
    United States v. Slaughter, 
    891 F.2d 691
    , 697 (9th Cir. 1989)
    UNITED STATES v. SANDOVAL-MENDOZA                    19963
    vulnerable to inducement is highly relevant to an entrapment
    defense. If it is adequately supported by medical expert opin-
    ion, it is admissible. Sandoval-Mendoza’s experts were well
    qualified and had sufficient expertise in the neurology of
    brain tumors and his particular case to be useful to the jury.
    The district court’s exclusion of medical expert opinion testi-
    mony prevented Sandoval-Mendoza from showing lack of
    predisposition, “and thereby deprived him of a fair opportu-
    nity to defend himself.”49 In this case, the foundation was suf-
    ficient. After hearing Drs. Mendius and Shore, the jury could
    have decided to disbelieve them. But Sandoval-Mendoza was
    entitled to have the jury decide upon their credibility, rather
    than the judge. As it was, the jury was left with nothing but
    unpersuasive lay evidence on a medical matter beyond what
    laymen could usefully testify about.
    [11] The district court excluded the medical expert opinion
    testimony alternatively in order to avoid “unfair prejudice,
    confusion of the issues, or misleading the jury, or by consider-
    ations of undue delay, waste of time, or needless presentation
    of cumulative evidence.”50 But there could be no “confusion
    of the issues” because predisposition was the issue. Sandoval-
    Mendoza’s only defense was entrapment, and entrapment
    came down to predisposition. And there was no risk of “mis-
    leading the jury.” The experts agreed Sandoval-Mendoza has
    an unusually large brain tumor. Their only disagreement was
    whether it caused susceptibility to inducement. The jury was
    capable of weighing the conflicting medical expert opinion
    testimony against the rest of the evidence presented and deter-
    mining whether or not predisposition existed. As for “undue
    delay,” testimony would likely consume no more time than
    the Daubert hearing, and probably much less.
    [12] Without the medical expert opinion testimony, the real
    issue in dispute was hidden from the jury. It could not deter-
    49
    United States v. Slaughter, 
    891 F.2d 691
    , 698 (9th Cir. 1989)
    50
    Fed. R. Evid. 403.
    19964        UNITED STATES v. SANDOVAL-MENDOZA
    mine whether the government’s informants induced a vulnera-
    ble and suggestible man to break the law. The informants did
    not testify, so the jury could not evaluate the pressure they put
    on Sandoval-Mendoza. It could not evaluate the merits of
    Sandoval-Mendoza’s suggestibility, because the medical
    expert opinion testimony concerning the possibility his tumor
    or limited mental capacity made him susceptible to induce-
    ment was excluded. All the jury had was proof that Sandoval-
    Mendoza sold drugs, wiretap recordings in which he sounded
    like an experienced drug dealer, and a couple of lay witnesses
    testifying that he was addled by a brain tumor. Sandoval-
    Mendoza is entitled to present his case to the jury. For that,
    he deserves a new trial.
    Because this error requires reversal, we need not reach
    Sandoval-Mendoza’s other claims.
    REVERSED.